Provider Demographics
NPI:1902860679
Name:VISION GROUP ASC, LLC
Entity Type:Organization
Organization Name:VISION GROUP ASC, LLC
Other - Org Name:ADVANCED CATARACT & LASER CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-782-8892
Mailing Address - Street 1:3002 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4232
Mailing Address - Country:US
Mailing Address - Phone:479-782-8892
Mailing Address - Fax:479-782-8840
Practice Address - Street 1:3002 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4232
Practice Address - Country:US
Practice Address - Phone:479-782-8892
Practice Address - Fax:479-782-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC1632261QA1903X
ARAR4308261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200085810AMedicaid
ARP00287824OtherRAILROAD MEDICARE
AR159454128Medicaid
ARAR4308OtherLICENCE NUMBER
ARP00287824OtherRAILROAD MEDICARE
AR159454128Medicaid